B.I.D. Radiotherapy and Chemotherapy With CDDP/5-FU in Unresectable Pharyngeal Carcinoma: 10 Years Experience at the Centre Antoine-Lacassagne. Impact of Tumoral EGFR Level on Response and Survival

William Levin, MD
University of Pennsylvania Cancer Center
Last Modified: November 5, 2001

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Presenter: R.J. Bensadoun
Presenter's Affiliation: Radiotherapy, Centre A-Lacassagne, NICE, France
Type of Session: Scientific

Background

  • Combination chemotherapy/radiation therapy regimens are increasingly being employed in the management of advanced head and neck cancers.
  • There is emergening evidence that the proliferation of certain solid tumors is stimulated by various growth factors that bind to cell surface receptors.

    Materials and Methods

  • This is a retrospective analysis of patients with unresectable pharyngeal cancer treated with combination chemotherapy and twice daily radiation therapy.
  • Analysis was of 92 patients treated at a single institution.
  • All patients had unresectable stage IV squamous cell carcinoma of the oropharynx or hypopharynx.
  • Patients received continuous b.i.d. radiotherapy (2 daily fractions of 1.2 Gy, 5 days a week).
  • Total dose was 80.4 Gy for oropharyngeal tumors and 75.6 Gy for hypopharyngeal tumors.
  • Two or three chemotherapy courses of cisplatin (CP)/5-fluorouracil (5FU) were given during radiotherapy at 21-day intervals.

    Results

  • There was a significant incidence of acute toxicity; 89% incidence of grade III/IV mucositis; grade III dermatitis (72%); grade III/IV neutropenia (61%).
  • Overall survival at one and two years was 72% and 50% respectively.
  • Univariate and multivariate analysis identified several factors associated with longer survival, these included; good performance status; tumor location (oropharynx); decreased levels of EGFR.

    Author's Conclusions

  • These results confirm the efficacy of concomitant b.i.d. radiotherapy and chemotherapy in advanced unresectable tumor of the pharynx.
  • The overexpression of EGFR predicts a worse outcome in these patients.

    Clinical/Scientific Implications

  • Compared to historical studies examining single modality therapy, concurrent chemoirradiation appears to be more efficacious in the treament of advanced head and neck cancers.
  • Biologic therapies targeting growth factor receptors may further increase tumor control in these patients.

    Oncolink's ASTRO Coverage made possible by an unrestricted Educational Grant from Bristol-Myers Squibb Oncology and Pharmacia Oncology.



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